3 ms·

> Drug companies' profit models pretty much require them to focus on developing drugs that people have to use for the rest of their lives - that manage a condit

by mft_ 9y ago

> Drug companies' profit models pretty much require them to focus on developing drugs that people have to use for the rest of their lives - that manage a condition rather than treat it. Not true - there are plenty of examples of genuine cures developed and marketed by pharma. What drug companies do require is a return on their investment, which can be in the multiple-billions. This isn't evil-big-pharma stuff... this is just how any sensibly-run company operates, pharma or otherwise. Achieving an ROI is seen as difficult in this particular case because (as TFA says) people don't value vaccines highly enough because they are taken when they're well, and (as you say) they're only needed once. (Personally, I think the article over-estimates this challenge; sell 100m doses at $50/dose and [assuming CoG is not a problem] you've got a major blockbuster. Even if the NHS/insurers didn't want to pay, employers and individuals likely would, at this price level. And 100m doses is pretty low-ball, if you consider the likely uptake of a vaccine promising a genuine cure for the commonest cause of the common cold.) - > Is there a good reason why we shouldn't club together as rich countries and fund a not-for-profit drug research body that does fund this sort of thing? I've wondered about this in the past. I think a major aspect is risk. If it was easy to pick a disease to cure and a way to do it, then we'd not be in this situation in the first place - developing drugs is actually incredibly difficult and unpredictable. This is well-demonstrated by an analysis published in Forbes a few years ago. https://www.forbes.com/sites/matthewherper/2013/08/11/the-cost-of-inventing-a-new-drug-98-companies-ranked/ https://www.forbes.com/sites/matthewherper/2013/08/11/the-co... Rather than taking an individual drug and pricing the work done on it to bring it to market (as with many previous studies) this analysis looks at total R&D spend by individual pharma companies over time, and divided that spend by the number of new drugs brought to market. As such, it takes into account the extraordinarily high rate of attrition in drug development - the time and money spent on countless thousands of drug candidates that are abandoned before the ever make it to market. (Note the analysis does have one major weakness, but now's not the time.) To quote the article: "For companies that have launched more than three drugs, the median cost per new drug is $4.2 billion; for those that have launched more than four, it is $5.3 billion." And there's the rub: I'm sure you could find some way of funding a few hundred million if it was guaranteed to result in a cure for a disease - Governments, the Gates Foundation, etc. But do such bodies genuinely have the will to spend countless billions, every year, to chase those few new treatments that might --or might not-- emerge? And having found a new treatment, would they just give it away... or would they want to recoup some of the costs they'd invested?

nonbel 9y ago
>"there are plenty of examples of genuine cures developed and marketed by pharma." Name one.
- mft_ 9y ago
  Abbvie (Mavyret) and Gilead (Solvadi, Harvoni) have both developed and marketed treatments which cure Hepatitis C. Roche sells MabThera which (together with chemotherapy) cures about 2/3rds of a common type of lymphoma. They also recently failed with a large phase III study in this setting, having hoped to cure even more people with an improved treatment. Celgene and Abbie/Pharmacyclics both have large phase III trials running in the same disease, aiming to cure more patients through the addition of their drugs to the current standard-of-care treatment. Novartis has just launched Kymriah, a CAR-T treatment which offers the prospect of long-term remissions in paediatric ALL. (Too early to say whether some of these will effectively represent cures.) Various pharmaceutical companies are attempting to develop new antibiotics, which would cure infections. (Just recent examples, and off the top of my head...)
  - tialaramex 9y ago
    I was like "MabThera?" but then I Googled it and that's Rituximab which I'd heard of. I had Hodgkins (which is one of the less common Lymphomas) so I got ABVD which doesn't involve Rituximab, but I read about loads of the chemotherapy drugs because I was morbid.
  - nonbel 9y ago
    The closest you came to naming one was MabThera. I'll check it, thanks. Edit: Oops, also Harvoni, etc.
caf 9y ago
The influenza vaccine has to be administered every year, and employers & individuals do choose to pay for it.
sleavey 9y ago
I guess my statement that drug companies are only interested in long term treatments was a bit sensational, but as we both agree, they need a return on their investment. I understand that developing drugs is both intellectually hard and extremely expensive, but there are in my view a few benefits that (super)national collaborations have over private companies: - you only need one cure, so the work only needs to be done successfully once (competition is in this case potentially wasteful) - knowledge and good people are pooled (not hoarded by the companies able to offer the best compensation) - access to larger sources of funding for individual projects - knowledge from failed projects could be publicly disseminated instead of locked up in the company's archives - no need to turn a profit The usual arguments I hear against state- or superstate-run organisations over the private sector is, as others have said here, the perceived wastes of resources when projects don't appear to be on a successful track: a private company would cancel early to avoid more waste, whereas a publicly funded organisation wouldn't necessarily do so as the project managers aren't incentivised by shareholder value. However, it seems to be to be just a case of having the right incentives. If they were instead tasked with improving patient outcomes measured over, I don't know, 10 years, then that could be a valid reason to use to cancel research that doesn't seem to be going anywhere ("it doesn't seem like this drug, even if it passes trials, will make a meaningful improvement in patient outcomes"). Another aspect of public organisations could be that the scientists in charge of the research would have their own reputation to consider, instead of that of the company. It would be in their own interest for costly projects to fail quickly if they go nowhere. Here's a thought: would it work if such a public organisation could underwrite the research of private drug companies? These companies could then be paid a "non finders fee" for failed drug projects that nevertheless showed significant promise, in return for low-cost access to the successful ones, and of course public sharing of the reasons why the drug failed. Would the economics of such a system work, or would drug companies find ways to game the system?

by mft_ 9y ago

nonbel 9y ago

>"there are plenty of examples of genuine cures developed and marketed by pharma." Name one.

mft_ 9y ago
Abbvie (Mavyret) and Gilead (Solvadi, Harvoni) have both developed and marketed treatments which cure Hepatitis C. Roche sells MabThera which (together with chemotherapy) cures about 2/3rds of a common type of lymphoma. They also recently failed with a large phase III study in this setting, having hoped to cure even more people with an improved treatment. Celgene and Abbie/Pharmacyclics both have large phase III trials running in the same disease, aiming to cure more patients through the addition of their drugs to the current standard-of-care treatment. Novartis has just launched Kymriah, a CAR-T treatment which offers the prospect of long-term remissions in paediatric ALL. (Too early to say whether some of these will effectively represent cures.) Various pharmaceutical companies are attempting to develop new antibiotics, which would cure infections. (Just recent examples, and off the top of my head...)
- tialaramex 9y ago
  I was like "MabThera?" but then I Googled it and that's Rituximab which I'd heard of. I had Hodgkins (which is one of the less common Lymphomas) so I got ABVD which doesn't involve Rituximab, but I read about loads of the chemotherapy drugs because I was morbid.
- nonbel 9y ago
  The closest you came to naming one was MabThera. I'll check it, thanks. Edit: Oops, also Harvoni, etc.

caf 9y ago

The influenza vaccine has to be administered every year, and employers & individuals do choose to pay for it.

sleavey 9y ago

I guess my statement that drug companies are only interested in long term treatments was a bit sensational, but as we both agree, they need a return on their investment. I understand that developing drugs is both intellectually hard and extremely expensive, but there are in my view a few benefits that (super)national collaborations have over private companies: - you only need one cure, so the work only needs to be done successfully once (competition is in this case potentially wasteful) - knowledge and good people are pooled (not hoarded by the companies able to offer the best compensation) - access to larger sources of funding for individual projects - knowledge from failed projects could be publicly disseminated instead of locked up in the company's archives - no need to turn a profit The usual arguments I hear against state- or superstate-run organisations over the private sector is, as others have said here, the perceived wastes of resources when projects don't appear to be on a successful track: a private company would cancel early to avoid more waste, whereas a publicly funded organisation wouldn't necessarily do so as the project managers aren't incentivised by shareholder value. However, it seems to be to be just a case of having the right incentives. If they were instead tasked with improving patient outcomes measured over, I don't know, 10 years, then that could be a valid reason to use to cancel research that doesn't seem to be going anywhere ("it doesn't seem like this drug, even if it passes trials, will make a meaningful improvement in patient outcomes"). Another aspect of public organisations could be that the scientists in charge of the research would have their own reputation to consider, instead of that of the company. It would be in their own interest for costly projects to fail quickly if they go nowhere. Here's a thought: would it work if such a public organisation could underwrite the research of private drug companies? These companies could then be paid a "non finders fee" for failed drug projects that nevertheless showed significant promise, in return for low-cost access to the successful ones, and of course public sharing of the reasons why the drug failed. Would the economics of such a system work, or would drug companies find ways to game the system?